Intro to stroke 4 - risk factors (+some drugs)

Question 1

what are the two groups of risk factors - give some examples

Answer 1

modifiable

• smoking
• obesity
• diabetes
• sedentary lifestyle
• diet
• hypertension
• martial fibrillation
• drugs/alcohol
• OCP

non-modifiable

• previous stroke
• age
• male
• FH

Question 2

how does hypertension add to stroke risk

Answer 2

most important modifiable risk factor - exacerbates atheroma and increases involvement of smaller distal arteries
increased LDL-C deposition in arterial walls

Question 3

how does smoking add to stroke risk

Answer 3

2x increased risk of cerebral infarction
3x risk of SAH
some increased risk linked to complications of cardiac problems - increased LDL-C deposition in arterial walls

Question 4

how does diabetes and lipids add to stroke risk

Answer 4

DM increases incidence 3x
increased LDL-C deposition in arterial walls
increased development of atheroma

Question 5

how does alcohol add to stroke risk

Answer 5

heavy drinking = 2.5x risk

Question 6

how does obesity add to stroke risk

Answer 6

especially abdominal/thigh

- independent risk factor for vascular disease

Question 7

how does atrial fibrillation add to stroke risk

Answer 7

5x risk of embolic stroke

higher mortality and morbidity

Question 8

NOTE - studies show oral anticoagulants are more effective in reducing stroke risk than aspirin

Answer 8

this is across both people who had experienced a previous stroke and those who had not

Question 9

NOTE - studies show antithromboitc treatments with anticoagulants or anti platelet agents are underused

Answer 9

warfarin is particularly underused due to perception o high bleeding risk, INR monitoring and comobidities eg falls risk, dementia

Question 10

why are DOACs considered tp be better than warfarin

Answer 10

overcome limitations of warfarin including monitoring, slow onset action, bridging, and multiple drug interactions

safer and more cost effective

Question 11

what DOACSs have the highest expected incremental net benefit in stroke patients

Answer 11

1. apixaban 5mg twice daily
2. rivaroxiban 20mg once daily
3. edoxaban 60mg once daily
4. dabigatran 150mg twice daily

Question 12

investigations for stroke

Answer 12

FBC - polycythemia (more blood, viscous - higher stroke risk), increased WCC (infection), lipids
Carotid doppler - carotid stenosis
ECG
CT angio
Inflammatory markers - vasculitis
Echo - valve problems, patent foramen ovale

Question 13

thrombolysis

Answer 13

Can only be done up to 4.5 hours after onset

Rule of thumb - if ticks all 3 criteria - thrombolyse (even if symptoms have been going for <1hr)